Individual
MR. DOUGLAS TYLER COULTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN, CRNA
Contact information
Practice address
200 ABRAHAM FLEXNER WAY, LOUISVILLE, KY 40202-2877
(502) 587-4404
(502) 587-4156
Mailing address
PO BOX 909, LOUISVILLE, KY 40201-0909
(502) 588-0328
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4004614
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300078204
—
IN
05
—
7100904280
—
KY
Enumeration date
05/24/2023
Last updated
07/26/2023
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